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Healthy Life Expectancy and quality

of life in old age

Carol Jagger

AXA Professor of Epidemiology of Ageing

6 June 2013

Outline

• Challenges of an ageing population

• Quality of life in very old age

– frailty

– level of care needed

• Inequalities in Healthy Life Expectancy

– local areas in UK

– ethnic groups

– EU countries

• What might the future hold?

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Challenges

• 51% in 65+ 2010-30

• 101% in 85+ 2010-30

• 10.7m can expect inadequate

retirement incomes

• 50+% in people with 3 or more

long-term conditions 2008-18

• 80% in 65+ with dementia

2010-30

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Main barriers to improving health

• Income inequalities

• Early onset of chronic disease

• Comorbidity at older ages

• Growth in dementia

• Growth in mental illness

Les Mayhew (2010)

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The clock is ticking….

• Life expectancy in the UK is increasing at the rate of two

years every decade, or around five hours each day

• Historically LE main indicator of population health

• Health expectancies combine quality and quantity of life

and address whether extra years of life are

– healthy ones (compression of morbidity)

– unhealthy ones (expansion of morbidity)

“ Increased longevity without quality of life is an empty prize.

Health expectancy is more important than life expectancy.”

Dr Hiroshi Nakajima, Director-General WHO 1997

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Health expectancies

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• More info in Longevity

Bulletin Issue 4

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Quality of life at very old ages

6 June 2013

Why focus on very old ages?

• Population aged 85+ fastest growing section

• Their health and care needs impact not only on health

services but on their families

– Next generation down are the ones who will care but who are

being required to work longer

• The health profiles of the very old are different – much

higher prevalence of

– Dementia

– Frailty

– Multimorbidity

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Prevalence of dementia

Source: Lobo et al (2000)

Prevalence of dementia doubles every 5 year increase in age

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Frailty-free life expectancy - methods

• SHARE wave 4 (2010-11)

— Austria, Belgium, Czech Republic, Denmark, Estonia, France, Germany,

Hungary, Italy, Netherlands, Poland, Portugal, Slovenia, Spain, Sweden

• Sullivan’s method

– life table for each country and sex from www.eurohex.eu

• Combined SHARE Frailty Index (SHARE-FI) and Global

Activity Limitation Indicator (GALI) to create 4 states

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Frailty-free life expectancy

• At all ages, women spend

more absolute years and

greater proportion of

remaining life pre-frail, frail

and with severe disability

• Relatively short time spent

frail and not severely

disabled

• Short window of

opportunity pre-frail for

prevention

• This does not tell us how

much care is needed

6 June 2013 11 Source: SHARE wave 4

Newcastle 85+ Study

A 5-year prospective study

of 1042 individuals born in

1921 of the biological,

clinical and psychosocial

factors associated with

healthy ageing

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Multimorbidity is the norm

Source: Newcastle 85+ Study: Collerton et al (2009)

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Disease Count

4.1

10.6

16.1

23.6

19.5

12.3

7.5

4.1

2.1

0.0

0.0

1.8

7.3

16.9

23.7

18.0

16.4

8.4

5.0

1.6

0.5

0.5

0.0

5.0

10.0

15.0

20.0

25.0

1 2 3 4 5 6 7 8 9 10 11

Disease Count

Perc

enta

ge

Men

Women

Interval-need dependency*

• Critical-interval dependent (requires 24-hour care)

– SMMSE < 10/ severe or profound urinary incontinence with inability to

dress or undress without help/ unable without help to perform:

toilet/chair/feeding

• Short-interval dependent (requires help at regular times daily)

– Unable without help to perform : bed/dressing and undressing/ hot

meal/medication/washing face and hands

• Long-interval dependent (requires help less than daily)

– Unable without help to perform: washing all over/shopping/light

housework/heavy housework/managing money/toenails

• Independent

Source: Isaacs and Neville (1975)

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Projected numbers in E&W aged 80+ by interval-need

dependency, 2010-2030

79%

80%

76%

91%

Independent

Source: Jagger et al (2010)

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Years with interval-need dependency from age 85

• Multistate analysis of baseline

and follow-up at 1.5, 3 and 5

years

• Assumption of no recovery from

help daily or 24-hr care

• Most years spent needing help <

daily

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Inequalities in Healthy Life

Expectancy

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Source: Bone et al (1995)

Male LE at birth by local area, 1991

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Life expectancy (LE) &

Disability free life

expectancy

(DFLE) across local areas in E&W

1991 (top) and 2001 (bottom)

Women (left) and Men (right)

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Change in LE vs DFLE between 1991 and 2001 UK LAs

At birth 85+

England Wales Scotland Northern Ireland

Ideal for

compression of

disability

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74.8

70.1

63.8

Expected age at disability onset for 55 yr old

Ponteland South

68.0 71.5

Inequalities within Newcastle

Courtesy Prof Peter Gore/Prof Carol Jagger/ONS

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LE and DFLE at birth by ethnic group, 2001

Asian White Mixed Black Other

Differences compared to White British

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Ethnic differences in DFLE

• Variation in DFLE at birth: men 12.7 years, women 13.9 years

– double that of life expectancy

– greater than variation by socioeconomic status

• DFLE at birth highest for Chinese men & women

• Lowest DFLE in Bangladeshi men & Pakistani women

• Over half of ethnic groups (men:10, women:9) significantly

lower DFLE than White British

• Indian women LE similar to White British, but low DFLE

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Healthy life years (HLY)

• EU committed to improving the health of its population

• Preferred measure is Healthy Life Years (HLY) measuring remaining years

free of activity limitation

• HLY are based on the Global Activity Limitation Indicator (GALI) question in

the EU Statistics on Income and Living Conditions (SILC) survey

• In 2004 Healthy Life Years (HLY) added to the list of EU structural

indicators

“Increasing healthy life years will be a crucial factor in achieving this objective

(of modernising social protection systems and strengthening pensions and

healthcare).”

(2005 Spring Council)

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LE and HLY at 65 by gender, 2008-10 average

• EU27 LE

– 6.5 yrs (M)

– 20.1 yrs (F)

• EU27 HLY

– 8.4 yrs (M)

– 8.6 yrs (F)

• Range LE

– 5.5 yrs (M)

– 6.3 yrs (F)

• Range HLY

– 10.3 yrs (M)

– 11.9 yrs (F)

25 Source: OECD Health at a Glance (2012) 6 June 2013

Source: EHLEIS

Potential to increase working life – HLY at 50, 2005

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What might the future hold?

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Monitoring population ageing

• Main goal for the European Active and Healthy Ageing Partnership

(EIPon-AHA) is to increase HLY at birth by 2 years over the next 10

years (2.4 months per year)

• If current trends (2005-10) continue will EIPon-AHA target be met?

• Will target be met by individual Member States?

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HLY projections 2010-2020 men, sample of countries

Scenario 1: current trends in %HLY/LE continue

Scenario 2: HLY gap closed in 20 years (50% reduction of gap in 10 years)

Scenario 3: As Scenario 2 + each MS increase of 2 HLY over decade

Scenario 4: As Scenario 2 + each MS has no increase in UnHLY (LE-HLY)

Projected increase in HLY (years)

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What does the future hold for Europe?

• If current trends continue

– 9 countries will reach EIPon-AHA target of an increase in 2 HLY over

the next decade

– Countries reaching target include Eastern European countries

– Romania unlikely to reach target as HLY decreasing

– EU27 overall will not reach EIPon-AHA target

– Inequity between countries will increase

• Improving the health of European people will need action on

many fronts and measures to address level and distribution

of HLY

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Challenges and solutions

• Doubling of numbers aged 85+

• Growing numbers of older people from ethnic minorities with generally worse

DFLE

• Inequality in healthy life expectancy seems to be increasing across UK

• But LE is still increasing!

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Acknowledgements

• Newcastle 85+ Study (see

www.ncl.ac.uk/iah/research/areas/biogerontology/85plus/ for

more details of study and publications

• EU funded Joint Action European health and Life Expectancy

Information System (JA EHLEIS) (www.eurohex.eu)

• ESRC funded Inequalities in Healthy Active Life Expectancy

(InHALE) study (http://research.ncl.ac.uk/InHALE/index.html)

• Dr Roman Ortuno-Romano (frailty-free LE)

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The views expressed in this presentation are those of the presenter.

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